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Mr. Archy Kirkwood (Roxburgh and Berwickshire) : I do not intend to follow the right hon. Member for Castle Point (Sir B. Braine), whose views are well known. He stated his case with emotion and passion, and I feel sure that we shall return to the question of embryo research, which will be an important feature of our future debates on health and welfare.

Many other items should be on the Government's agenda but are not, and neither have they been mentioned today. They include provision for the homeless, social security measures, the problems that flow from AIDS, war widows' pensions and other important matters. I want to refer specifically to the Secretary of State for Health's initial exchanges across the Dispatch Box with the official Opposition about resources, which are at the heart of the problems affecting the Health Service. I become profoundly frustrated and depressed when I hear Ministers trotting out statistics about the number of new doctors and nurses and about real increases in expenditure, while Opposition Members mouth statistics on the number of hospital and ward closures and the difficulties that they confront in their constituencies. It must be difficult for the general public to make any sense of arguments conducted in these terms. I often wonder

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what the public, and patients in particular, make of our debates. They do not always help to inform or improve the situation. Any Government would have difficulty in producing the sums of money that I would like to see spent on the Health Service, but of course Governments are constrained by having to husband the public purse. Although £29 billion is a good deal of money in absolute terms, it is not such a large sum in relative terms, when compared with the amount that our sister European democracies are devoting to finance their health services. It is worth remembering that the proportion of national wealth that we provide for the NHS is certainly not wildly in excess of the equivalent proportions provided by those countries. Opposition Members, of course, make endless demands for more money for the NHS. The increases that the Government have secured over the past two public expenditure rounds were very welcome--£5.2 billion is a lot of money--but the professions and others who work within the NHS would like to know whether the increases announced so proudly by the Secretary of State this afternoon represent a regular level of increase that may be sustained in the future. They would be willing to learn to live with that, but the trouble is that this welcome expenditure has been wrung from the Government like blood from a stone.

I understand the Secretary of State's concern about those successful hospital units that develop new techniques and provide a high level of patient care which run out of funds early in the financial year. A way around that problem, however, would be to introduce a rolling programme of expenditure, which would give district and regional authorities some idea of the amounts available to them over the coming years. We need to agree on a funding formula. In my view, the best formula is that suggested by the Select Committee on Social Services, which recommended that base funding should consist of the real cost of inflation to the NHS, plus 2 per cent. That, I feel, would lead to better organisation in the long term.

Mr. Jeremy Corbyn (Islington, North) : Does the hon. Gentleman agree that one way of improving expenditure on health care would be to reduce arms expenditure, at least to the same level as in other western European countries? That would lead to a saving of some £5 billion, which would provide at least some of the resources that are urgently needed to stop hospital closures and the loss of hospital beds in every district health authority.

Mr. Kirkwood : That conveniently illustrates a different point. It is, of course, difficult to assess precisely the amounts required by the NHS, but it does not take a genius to work out that the money spend in the NHS is dominated by staff costs--which are spiralling above the retail price index--and that NHS expenditure must increase by substantially more than inflation. It is no use the Government talking about real increases without taking that factor into account. Nor is there any point in the Secretary of State's beating his chest about the money that he has managed to squeeze out of the Treasury : that money should be seen against a 10- year-old background of under-funding. According to the Select Committee, £20 billion is needed just for capital investment in the fabric of our hospitals, wards and community health centres.

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No doubt hon. Members on both sides of the House find that the current demographic changes are reflected in their constituency work. As a larger proportion of the population are now aged 75 or more, the demands on the Health Service must of course increase. It costs £3, 500 to look after the average 85-year-old, while only one tenth of that is needed to look after the average Member of Parliament who is--as I am--rapidly approaching middle age. [Interruption.] I am older than I look, and this business does not make any of us look any younger.

Mr. Menzies Campbell (Fife, North East) : It is the triumph of hope over experience.

Mr. Kirkwood : It is indeed.

We all welcome the technological developments that are now benefiting our constituents, and those developments must continue apace ; but there is no point in scientists and research technologists devising new methods of treatment if those methods are not made as widely available as possible. Let me make a plea for a measure of continuity and agreement in regard to the amount of money that we need to maintain standards--which is all that the Select Committee was trying to achieve--before considering what potential enhancements are possible. We are talking about big money. If the Government take a Treasury view of life, the Health Service will never escape from the bind that it is in now. We must take a wider view. I am not arguing for profligate expenditure ; I believe that the public would respond to a sensible, moderate approach. We must, of course, get the management structures right, but I think that the Government would be pleasantly surprised by public reaction to a sensible commitment to continuous increases in real-term expenditure on the NHS.

In many respects, the Government's approach has been

irresponsible--and I say that as one who is not given to extreme language. The confidential basis on which the NHS review was conducted was scandalous : there was no participation by any of the professional bodies or pressure groups. The Secretary of State made matters worse by gratuitously alienating health professions--the GPs in particular--by accusing them of being interested only in their own incomes.

That is a scandalous calumny. I have talked to doctors throughout the country who are perfectly happy to accommodate the Government with peer group reviews, medical audits and many other positive aims which could have been pursued much more vigorously and successfully had the Government approached the professions with more humility and common sense.

The hon. Member for Livingston (Mr. Cook) was right to say that there was no mandate for this reform : certainly the last Conservative manifesto did not mention it. Now the Government are railroading it through in the teeth of opposition--and not only from the public. I sympathise with the Government's objection to some of the statements made by the more extreme pressure groups, which may indeed misrepresent the Government's position, but I do not believe that the public will support this measure when they come to understand it more fully.

It is a pernicious attempt to tinker with the administration and to put in place a system that will enable the Government to keep down costs. If that policy is

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pursued religiously, as I am sure that it will be, and whipped through the House, there will be a massive drop in the morale of those who work in the National Health Service. If the Government think that they can survive such a drop in morale for a long time, especially with the manpower crisis, most of all in the nursing profession, they are very much mistaken. That would be bad news for the House of Commons, bad news for the Government and, worst of all, bad news for patients.

Mr. Paddy Ashdown (Yeovil) : Last Thursday night there was a parish ballot in my constituency--the first of its kind in Britain--on the Government's proposals, particularly on the question of the local hospital opting out of the National Health Service. The result of the ballot was that 97 per cent. were against opting out.

Mr. Kirkwood : I am not surprised to hear that. It is the general outcome of such ballots.

As these measures are considered by the House of Commons, the amount of opposition will increase. At the next general election, the Government will find it very difficult to defend their legislation. I hope that they will get their comeuppance. If they do, they will deserve to lose all the seats that they then lose.

5.51 pm

Dame Jill Knight (Birmingham, Edgbaston) : In Health Service matters there is an unholy alliance between the press and the Opposition to make good seem bad, advance seem retreat and truth seem lies. Good news does not sell papers, and it does not win votes for the Opposition.

In another context, my hon. Friends will have noted that, whenever there is a reduction in unemployment, the Opposition are glum and miserable. Down, therefore, with any good news--do not print it, do not mention it, or better still, manipulate it in to seeming bad news. It is much more clever, they say, to trumpet from the housetops that such and such a hospital is closing. If it is old and has been open for a long time, they think that there must be many people who have received treatment there who will speak of it with gratitude and affection and will regret its closure. The Opposition try to get those aspects in front of the cameras, and they like to talk about them in the House. They never let on for a moment that a beautiful new hospital is opening instead. They keep quiet about that. They never let on that the new hospital will provide better treatment, new wards and better conditions.

There was a perfect example of that in Birmingham, when the old children's hospital was closed. Some of us had been trying to get a new children's hospital for years. Children had to be wheeled across an open yard to the operating theatre. We succeeded in getting a new children's hospital, but did the Opposition say one word about it? Dear me, no--all that we heard about from them was that the old hospital was being closed.

Under this Government, 270 major hospital schemes in England alone have been started and completed, and 530 more schemes are in hand.

Mr. Corbyn : What about the closures?

Dame Jill Knight : What a silly comment that was. It does not matter if a hospital closes, so long as a better and more modern hospital where patients can be treated is opened.

Mr. Corbyn : Will the hon. Lady give way?

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Dame Jill Knight : If the hon. Gentleman wants to make such silly remarks, he might as well tell us all.

Mr. Corbyn : A number of new hospitals have been built.

Dame Jill Knight : This is the first time that the hon. Gentleman has admitted that.

Mr. Corbyn : During the last 10 years, however, a very large number of hospital beds have been lost to the NHS on account of closures. When new hospitals have been opened, fewer beds have been made available in many of them--hence the very long waiting lists. The experience of most people is that they are getting a much worse service now from the NHS than they did 10 years ago.

Dame Jill Knight : That is what the hon. Gentleman wishes were the case, but it is not true. I do not know how the hon. Gentleman has the nerve to get up and talk about hospitals when not one new hospital was opened when a Labour Government were in office. There were plenty of ward closures at that time, too.

All that the Opposition want to do is to turn good news round and hide it. They say, "Let us find a tired nurse, play up how hard she works for her patients and say how dreadful it is that she cannot be paid more." They do not breathe a word to the effect that her pay has increased, on average, by 44 per cent. under this Government, and that is after taking inflation into account. There is no reason why the Opposition should not mention that nurses may be tired, but they never mention that they are now paid more than they were under Labour.

The Opposition also say : "Let us find a baby who is going to die on account of complications after a premature birth, but whatever we do, we must not let the news get out that many, many babies who certainly would have died 10 years ago are able to be saved today." Premature babies present very difficult problems, but about 35 per cent. of those who would certainly have died a few years ago are now being saved. Of course that is a tribute to the cleverness of the medical profession and the doctors, but let nobody think that it is done without money. That work is being funded.

The Opposition employ the same tactics in relation to Health Service review. It is portrayed as an attack on the NHS, but it is a vital life- saving measure. New treatments, new operations and new drugs are very expensive. We cannot continue to waste money in the way that it was wasted for so many years. Of course patients should be given a better service, and it should be universally good in the NHS. Why, I ask myself--I am sorry that Opposition Members do not ask themselves the same question--should patients in Merseyside have to wait three times longer for a hip operation than patients in London? Why do some doctors prescribe valium and mogadon for years on end instead of treating their patients? I know of one young woman who was prescribed valium for seven long years without one medical examination by her doctor. That is wrong for both the patient and the NHS.

Mr. Terry Fields (Liverpool, Broadgreen) : Will the hon. Lady give way?

Dame Jill Knight : No, the hon. Lady wants to finish her speech because other hon. Members want to take part in the debate. [Interruption.] The hon. Gentleman will, I am

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sure, have an opportunity to make his speech. He has not been here throughout the debate, as I have, and I am determined to make my speech in my own way.

Why do some orthopaedic surgeons carry out more operations in one month than others do in six? Why are some hospitals user-friendly while others are a misery to enter? There is undoubtedly a need for big improvements in the NHS. That is what the review is about. The object of the review and of the Bill is to improve services for patients. The hon. Member for Wolverhampton, South-East (Mr. Turner) was in danger of being struck down with apoplexy in the Chamber when he made a great hoo-hah about waiting lists. A lot of people who have been sent for hip operations could not have had them at all 15 or 20 years ago. We now are all aware of people who have had those operations.

There is no doubt that we must work harder to get rid of the waiting lists, and the Government have devoted a great deal of money to that end. I do not like the fact that my constituents waiting for kidney operations are told that only a certain number of operations can be carried out because of money constraints. When it is possible to alleviate a medical condition, it should be alleviated without delay. Those who imagine that we can continue to waste money without trying to improve the Health Service know nothing about the NHS. Why has the British Medical Association conducted its campaign against the improvements? The answer is simple. The BMA reacts with vehement objections to any suggestion of change at any time to any part of the Health Service. Not one reform has been mooted for the Health Service in the past 40 years to which the BMA has not reacted in that way. If any action is contemplated, the BMA believes that it must be wrong. I have a twin brother who was a rather mischievous child, and I recall that when I was young my mother used to say, "Go and see what John is doing and tell him to stop it." The BMA is like that. Its response to the review is "There is a review, something is being done about the Health Service--we must stop it at once." The BMA has not bothered to find out what the review means.

The document which the BMA produced against the review was full of phrases like "might be", "possibly", "could" and "maybe". I remember speaking to representatives of the BMA in my constituency months ago. I pointed out that many of the BMA's objections were pure conjecture. The BMA's response was completely negative and I am pleased that a counterblast is under way.

One of the sillier objections to the review of the Health Service has been repeated today--that the review and the Bill have been sprung on the medical profession. That is nonsense. For months we have been debating the details and there has been no secrecy about the leaflets and documents explaining what was intended in the review. Those documents were available to anyone who wanted them. We have already had months of debate and we shall soon be debating the Bill. A great deal of debate will take place shortly during the Committee stage. All Conservative Members recognise that there are faults in the Health Service. We are determined to put them right and we are not afraid to say what worries us. I am worried about community care for the mentally handicapped. One of my ministerial colleagues said recently that something is to be done about that problem.

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Much concern has been occasioned by people who have been let out of mental hospitals who could not manage by themselves in the outside world. That must stop.

The Health Service Bill should also contain positive proposals to obtain more organs for transplants. The advance of our Health Service has been remarkable. However, with regard to transplants, the shortage of organs-- not a shortage of money--is holding up operations. I have one or two ideas of my own on that subject which I may have the opportunity to put forward in Committee.

The terms of the amendment before us today are hypocritical. The object of the review is to safeguard the National Health Service. The Labour party is all about the failure to safeguard the Health Service. It could never produce enough money or care. Labour could not stop the waste or deal with the difficulties in order to safeguard the Health Service properly. Conservative Members are the most anxious Members in the House when the public cannot get access to treatment. The amendment is rubbishy and stupid and I hope that it will be defeated.

Several Hon. Members rose --

Madam Deputy Speaker (Miss Betty Boothroyd) : Order. The House will recall that Mr. Speaker determined that speeches should be limited to 10 minutes between 6 pm and 8 pm.

6.4 pm

Mr. Jack Ashley (Stoke-on-Trent, South) : The House always listens with respect to the hon. Member for Birmingham, Edgbaston (Dame J. Knight). However, if she really believes that the crisis in the National Health Service has been got up by the press, by Labour Members and by the BMA, she is out of touch with reality. I do not want to pick up those points, because I want to deal with some problems affecting disabled people.

For the past 10 years, this Government have been expressing deep concern about the disabled, and we should expect a pretty picture. However, instead, the picture is very disturbing. That situation has not been got up by the press, by Labour Members or by the BMA. Disabled people are disregarded people in Britain today. They are underprivileged and mainly very poor. Many of them are denied an adequate income for the additional costs of disability. They are also denied access to buildings and to public transport. Sometimes they are patronised, humiliated and neglected. Very often they suffer gross discrimination.

It is amazing that, while it is illegal to discriminate on grounds of sex or race in Britain, it is perfectly legal to discriminate on the grounds of disability. That is quite incomprehensible. Last Friday the BBC television programme "Public Eye" showed a damning indictment of society and of the Government's attitude towards disabled people. A disabled child was bombarded with abuse : "You are a spastic bastard. You are too thick to walk." That is what people said to a severely disabled child. The programme showed how a local authority had no power to act against the ignorant thugs who used that language because the Government have failed to accede to or accept

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legislation to outlaw discrimination. The people who harassed that child because he was disabled were perfectly entitled to do so. That programme also referred to an intelligent, qualified, computer-trained young man who sent 400 applications for jobs. All were rejected because of his deafness. I cannot see how we can allow that kind of discrimination to continue. Parliament's existing laws, which should help that young man, are frustrated by the Department of Employment's negative attitude. One committed official at the Department who was anxious to prosecute a firm for refusing to comply with the statutory requirements was told by her seniors : "We don't want to know. Prosecution is not our policy." A categorical statement in an internal review document states : "Work with disabled people is given little status and even less priority in the Employment Service."

I am sure that the Minister with responsibility for the disabled will be interested in that document, and I hope that he will read it after this debate.

What we have long suspected has now been officially stated--little status and even less priority. What an astonishing and despicable state of affairs in the department of Employment. With such attitudes, it is no wonder that the employment quota system, which was designed to provide jobs for disabled people, is being disregarded. The Department of Employment must answer some probing questions and revolutionise its attitude.

Other countries are leaving us far behind. West Germany has an effective quota and levy system to provide jobs for disabled people. The United States Senate has just passed the Americans with Disabilities Act. It is a marvellous Act, which stops discrimination in jobs, housing, education, transport and access generally. We should have such an Act. We should be leading the world but we are not : the Germans and the Americans are leaving us far behind. Our record is deplorable. The Government have rejected three Bills to outlaw discrimination. It is wrong for the Government to oppose Bills of that kind, especially when the Germans are doing so well with their legislation, and especially when the United States is leading the world in fighting for and protecting disabled people. Why can Britain not lead for a change? Why must we lag behind? I hope that the Minister will tell hon. Members about some innovation and some new ideas, and inform us what the Government intend to do. One of the most serious and striking manifestations of the Government's failure to protect vulnerable disabled people is the lack of community care. The system is not only inadequate but beginning to collapse. The slick and easy way of side- stepping the problem is to pass it to families. That is exploitation of loving family relationships, and the Government have given no commitment to extra help. They should have done so. The White Paper and Ministers state that we must have simple and cost-effective provisions. "Cost- effectiveness" is a reasonable concept to most people but not when it comes from Ministers' mouths. To some Ministers, cost-effectiveness means cutting and reducing.

I appeal to the Minister : we need not the patchy implementation of present community care nor inadequate implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986, but full,

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comprehensive implementation of community care for all disabled people who need it, and full implementation of the Act. That would go a long way towards helping the disabled people of Britain. I hope that the Minister will act.

6.13 pm

Mr. Timothy Raison (Aylesbury) : I will not repeat the remarks of the right hon. Member for Stoke-on-Trent, South (Mr. Ashley), but I will refer to aspects of community care in a minute or two. I pick up the point by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on behalf of the Social and Liberal Democrats. It is a travesty to say that the Government are not spending substantially on the National Health Service. There have been enormous increases last year and this year. I congratulate my right hon. and learned Friend the Secretary of State for Health on playing such a big part in bringing that about. It is unreasonable to expect that we can go much beyond that, as other matters are making great demands on the Government. Although I have withdrawn slightly and temporarily from education, the case for greater educational spending is particularly powerful. We must be realistic about the extent to which we can spend on the Health Service, important though it is.

Hon. Members will soon consider a Bill on embryo research. My right hon. Friend the Father of the House, the right hon. Member for Castle Point (Sir B. Braine) spoke with absolute certainty about what is right, and we all respect that. I must confess that I am one of those who have not yet made up their minds about what is right. I want to listen to the debate. It would be of great help if hon. Members were able to pursue more fully the latest and most up-to-date scientific views on what research is necessary and whether it has real value. I suggest to my right hon. and learned Friend the Leader of the House that this is surely a case for bringing into action the pre-legislative Committee that was introduced a few years ago but which now seems to have been dropped. That Committee could be uniquely valuable in summoning scientists before it to probe what they understand about the subject.

Reference has been made to AIDS. Although I respect my hon. Friend the Minister for Health, I have some queries about her latest announcement. Is it wise to carry out substantial testing for AIDS on the basis that no practical use is to be made of the findings? I believe as strongly as most people in the importance of statistics. I believe in social science ; it is an essential part of our apparatus. However, if we turn up information which discloses people suffering from that terrible disease, it seems perverse to make it impossible to make practical use of that information. By all means let people stipulate that, in their individual cases, no use must be made of the information, but it is wrong to reject the source of information. I hope that the Government will think again about that matter. I now refer to the National Health Service and Community Care Bill. I am happy to stress the second part of the Bill as well as the first. A year ago, I had two fears about those topics. One was that the Government would opt for an insurance-based National Health Service, and the other was that the Government would reject the Griffiths report. I am delighted that the essence of the Bill

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is to reject the insurance-based service and to accept the Griffiths report. It is important to state again and again that the National Health Service remains unchanged in its fundamental task of providing care for all who need it. I do not believe that the Opposition have begun to make a case against that.

I strongly welcome the self-governing hospital and the fund-holding GP practice. It must be repeated that they are options rather than compulsory ingredients in the Government's scheme. Hon. Members who say that 99 per cent. of their constituents, including doctors and everybody else, are against those options can presumably derive satisfaction from knowing that, in that case, they will not come about. They will not happen unless people want them. There is no need to worry.

Exactly the same applies to practice budgets. Again, they will be picked up only if doctors want them. I know NHS practitioners who consider the practice budget exciting rather than terrifying. They are right to do so. Like the self-governing hospital, the practice budget gives scope for the enterprising and decentralised leadership for which many people have been crying out over the years. Goodness knows how many times I have heard doctors in particular complain about centralised bureaucracy and the administrative burdens of the NHS. If something is done to try to relieve them, we should welcome it rather than collapse into a dismal gloom and say that nothing new can possibly work.

I have only one significant concern about the Bill as presented ; it relates to the question of choice. I have always believed that it would be an asset if we could honestly say that, among other things, the NHS reforms will offer everybody a greater choice of hospital, consultant and specialist, following the advice of, and in partnership with, one's general practitioner. However, the Bill as it stands does not achieve that. If I understand the provisions correctly, it is true that, in emergencies, it will be possible to bypass the contracts, but otherwise it looks as though the contract system will still present rigidity, which is a pity. If the Minister for Health can assure me otherwise, and if I have misunderstood the provisions, I shall be delighted, but if my understanding is correct, the Government should think hard about whether they can inject into the Bill more choice than there appears to be at present. As I have said, I support not only the health side of the Bill, but the community care side also. I understand--I think that we all understand--that this is perhaps the most difficult area facing the Department of Health in terms of implementing the legislation. It is astonishingly difficult. All of us have either seen harrowing programmes on television or come across harrowing cases in our constituencies of people being released from long-term care in a hospital or wherever, with unhappy results, sometimes leading to murders and suicides. We all know about that, and we must accept that the notion of community care embodies some degree of risk which is averted if people remain locked up or confined to institutions. Nevertheless, I am absolutely sure that the principle of community care is right.

I say that with perhaps greater certainty than some hon. Members could because in my part of the county of Buckinghamshire I have seen the promising start that has already been made in implementing a policy which, although it comes ahead of the Bill, is remarkably close to it in application. We have developed the sort of

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partnerships that are needed, and the Bill will facilitate such provision across the country. Above all, its great merit is the clear allocation of the responsibility for coping with such individuals that is assigned to local government. I profoundly hope that there will be no attempt to whittle away the essence of the Bill, however deeply we should be concerned about ensuring that we pick up all those in greatest need.

Finally, the question of housing provision runs parallel to that of community care. Although this was not in the Gracious Speech, we know that the Government have just said that they are going to put more money into tackling homelessness. That will be welcomed on all sides. However, we know not only that the whole question of homelessness is bound up with that of community care, but that it is still one of the major social problems affecting us today. Since 1979, we have had enormous success with the triumph of the right-to-buy programme, which I believe will never be reversed. However, I am frankly concerned about low-cost provision and about cheap rented housing in areas such as my constituency and other parts of the country. We should remember that this problem does not relate only to homelessness--serious though it is in, happily, limited parts of the country--but also to low-cost housing in a wider sense.

The Government put great emphasis on housing associations, which I support because they have an extremely good record. The Government are also trying as hard as they can to develop the private rented sector, and I support that also. In the long term, it seems nonsense that so little has been done to bring forward private provision. However, I am bound to say that we also need old-fashioned local authority council house building. I am not saying that that applies everywhere--I am sure that hon. Members can tell me of parts of the country where it is not necessary, but in some parts of the country, such as my own, it is necessary. Neither the private rented sector nor housing association provision leads to the right to buy, whereas building council houses does, and I firmly believe that the Government should not neglect that important part of the package. 6.24 pm

Dr. Kim Howells (Pontypridd) : I shall examine some of the claims that the Secretary of State made in defence of the Government's performance in looking after the National Health Service. I shall try to explain why a great many people deem the White Paper to be wholly inadequate to meet the enormous challenges facing those who administer and deliver the Health Service in our hospitals. The Health Service in Mid Glamorgan is particularly stretched. It is not a rich county ; it is a county with high morbidity rates and prevalence of illnesses, especially respiratory illnesses. Two years ago the health authority called in a private management consultancy, which recommended that the Mid Glamorgan health authority should have a replacement hospital in east Glamorgan. The district general hospital is now dilapidated and serves a population of no fewer than 180,000 people in the Rhondda and Taff-Ely valleys. The construction of that replacement hospital should have begun by now, but it has not.

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The private consultants who carried out the survey recommended a replacement hospital of 780 beds and considered that to be the absolute minimum for the existing and future needs of the district health authority. In turn, the health authority said that under no circumstances could it find the funding for more than 500 beds, which is even fewer than the 540 beds that we have at present. In the past few weeks, it has not been clear whether there will be sufficient funds to cover even that reduced number of beds.

Faced with that rapid deterioration in the hospital--there is talk of patients being turned away and of people dying because they cannot be treated--the consultants have gone public in demanding action. Things have come to a pretty pass. That militates against the views of the Secretary of State, who painted a picture suggesting that everything was all right and who said that the Government were doing very well in looking after constituencies such as mine.

I have therefore brought along a letter sent to me this week by Mrs. Olwen Williams, the consultant physician at East Glamorgan general hospital. She said :

"Because of cumulative under-funding and under-investment, nearly every part of the service provided at EGGH is under strain There is a growing sense of anger and frustration among the senior staff that successive generations of managers and administrators seem unable or unwilling to provide the resources the hospital needs. Estimated costs of outstanding maintenance work are £4.5 million There is a global shortage of beds, as we currently run at only slightly over half the recommended number for the population and workload. This has led to the closure of the hospital as a whole on one occasion this year, to the reduction and cessation of cold surgical operating on two occasions, to the admission of patients inappropriately to non-acute beds, to inappropriate early discharge of patients, and to the transfer of medical patients to surgical wards, geriatric patients to medical wards, patients sent home from Casualty rather than admitted, and a number of other undesirable practices Over the last 2 to 3 years, children have been nursed on the same ward as acutely ill adults, the Department of Gynaecology has been unable to use all its operating sessions, for lack of beds, even though they have long waiting lists".

Mrs. Williams also writes that the hospital is short of operating theatres, intensive care beds, coronary care beds and medical equipment. She states :

"Current requests for equipment exceed £400,000. This year's allocation was £42,000."

The hospital is 40 nurses short. Mrs. Williams continues : "There is an urgent need for a third consultant in Trauma and Orphopaedics, a third Geriatrician, a second Rheumatologist, a second Histopathologist, a fifth General Physician, a fourth General Surgeon, at least one more Anaesthetist and another Radiologist. As a Consultant Physician with an interest in diabetes, I am responsible for the diabetic population of 180,000."

Those facts cannot be defined, by any stretch of the imagination, as the record of a Government who are doing their best for the Health Service. That record is an absolute shambles and a disgrace. Those figures relate to just one hospital in a deprived area, but I am sure that many other right hon. and hon. Members could quote similar figures.

If there is any proper measure of humanity and intelligence of a civilised community, it is the provision of care for those who do not enjoy good health and who have no other means of looking after themselves. In constituencies such as mine there is no excess income to spend on private medicine. It is impossible for those people to take short cuts ; they need the Health Service. They look

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at the White Paper in desperation because they see that it does not meet their needs. Nor is there any suggestion as to how the shortages will be rectified.

The general hospital has tried to save money in many ways. It has put out to competitive tender all kinds of services. I have with me the pay slip of a woman in her 50s, Miss P. M. Coles, who works as a domestic at East Glamorgan hospital, as an illustration of the sacrifices made by my constituents so that the hospital can cut costs. The week before last that woman worked 36 hours and her take-home pay--it is here for anyone to see-- was £76.91. That is what competitive tendering is all about. Those are the sacrifices that are being made by real people at a real hospital. If we are prepared to accept that that is a proper way for a civilised society to treat not only its sick, but those who take care of them, future generations will look on us as uncivilised and will believe that we ignored our duty. We do so at our peril.

I am not calling for greater sympathy for people who have nowhere else to turn, but if we are to compete with other countries and other economies, as we are constantly exhorted so to do, one piece of our infrastructure that we must get right is the health of the nation. If areas are allowed to deteriorate to a state where high levels of chronic illness prevail, as is already happening in some constituencies of the coalfields, we cannot be confident about the future and our ability to compete.

The civilising influences of the late 19th century had to be dragged in. We had to drag the most deprived communities towards the 20th century by arguing that health had to be improved, that civic pride had to be engendered and that we should have pride in looking after each other. We are sacrificing that tradition of excellence on the altar of a dogma that, every day, is proving to be a false one. If we continue down that path we will be attempting to take a shortcut that leads us nowhere. That shortcut will not help us to compete--

Madam Deputy Speaker : Order. It really hurts me to stop hon. Members when they are in full flow, but I must apply the Standing Order.

6.34 pm

Mr. Ray Whitney (Wycombe) : I do not have the benefit of knowing the constituency of the hon. Member for Pontypridd (Dr. Howells), but I am certain that the Welsh health authority--in my experience an extremely good one--has shared in the increase in funding that all regional health authorities have enjoyed. That increase has led to more nurses and more doctors. If the picture that the hon. Gentleman painted of his constituency is the truth, he should go to the Welsh health authority to demand better treatment. I suspect that he will find that his constituency has also shared in the increase in funding, nurses and doctors. We all agree that we have not reached Utopia, and that is why we need to take a new look at the National Health Service.

Sadly, the hon. Member for Pontypridd, in common with the Opposition Front Bench spokesman, the hon. Member for Livingston (Mr. Cook), provided the same old litany and not a single new idea. Regrettably, that was the contribution, or should I say lack of contribution, from the spokesman for the Liberal Democratic party, the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). All we hear about is the need for more

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funding. I should like to consider the question of resources and to go back to the situation that prevailed in the spring of 1979. The House will recall that, in 1979, we were coming to the end of a period of Labour government. That period saw an actual cut of 20 per cent. in real terms in nurses' pay and a 30 per cent. cut in the hospital building programme. It was the time of the winter of discontent, and spending on the NHS stood at £8,000 million. Imagine if my party, the Conservatives, had stood on a platform during the 1979 election campaign and promised that, within 11 years, spending on the Health Service would have increased by 45 per cent. Imagine if we had run on a campaign that claimed that, in the forthcoming decade, there would be 67,000 more nurses, whose pay would, on average, be 43 per cent. higher in real terms than it was in 1979. Imagine if we had told the electorate in 1979 that there would, in 10 years, be 14,000 more doctors and 20 per cent. more general practitioners, that the average list size of GPs would decline by 300 and that those doctors would be paid, on average, 37 per cent. more in real terms than they were in 1979. If we had said that spending on health would increase by 1 per cent. of gross domestic product--our GDP is much higher than it was under the Labour Government--what would have been the reaction of the Opposition parties? They would have scoffed and scorned as they are doing now. What would have been the reaction of the media? We can imagine the editorials of the Daily Mirror and we might even imagine the editorials of some of the more moderate and balanced papers advising us not to be so ambitious or so boastful. What would have been the reaction of the British Medical Association or some of the royal colleges? They, too, would have scoffed, and they would not have believed our claim. If we had been able to convince the BMA that we were speaking the truth and that we could make the economy so strong that we could deliver that increase in funding and staffing, what would the BMA then have said? It could have said nothing but that its troubles were, to a significant extent, over, and that we would have a Health Service that satisfied all our demands.

We all know the reality, and we know that demands are far from satisfied-- no Conservative Member would dream of suggesting that those demands have been met. We should all understand the pressures that have caused that shortfall. We have the pressure of an aging population--I am happy that that is so--and the huge expense in medical care required as one moves into one's later years. There is also the pressure of medical advance, which we all welcome, which is tremendously expensive and demanding on resources. The Health Service also faces the pressure of rising aspirations. As a number of my hon. Friends have already said, Opposition Members mention the failures and the problems, but they never mention the great successes and advances that have taken place in prenatal care, old-age care and whatever else.

Great advances have been made, but great challenges still lie before us. If people were to look at this subject objectively, they would say that we have had 40 years of a basic structure, endless commissions and royal commissions, inquiries, surveys and reports, but that fundamentally the structure that was put in place in 1948, and opposed by the British Medical Association, is no longer able to stand up.

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Opposition Members should remember that the Conservative party was fully behind the then Minister for Health who, in 1944, introduced the White Paper which first established the principle of a National Health Service in this country which was available for all and free at the point of delivery. That is the principle to which we have adhered and on which the present proposals are founded. With the experience of the past 10 years and with the huge--in 1979, literally unbelievable-- increase in resources, we have reached a point where it must be clear to all but the most closed minds that simply providing more money is not the answer and will not possibly produce the answer.

We have come to expect closed minds among the Opposition and listen in vain for any new idea from the Labour party and what remains of the centre parties. However, we are deeply dismayed that the minds of those in the medical profession so often seem to be closed. Fortunately, there is now a sign that their minds are being opened. Contrary to what the hon. Member for Livingston said, there are signs that good sense is at last breaking out among a number of those in the medical profession. The 2,700-strong Hospital Consultants and Specialists Association rightly condemned the British Medical Association's appalling propaganda campaign and welcomed intelligent debate about the proposals which the Government have sensibly put forward.

People who are worried that so many doctors and the British Medical Association are against the proposals and believe that therefore those proposals must be wrong, must take account of the British Medical Association's record. In an otherwise excellent speech, my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) was wrong about one point. She said that the BMA had opposed medical advance for 40 years. It has actually opposed it at least from 1911, from the time of Lloyd George's National Insurance Act 1911. Once the Act had been in operation for two years and was seen to work, the BMA supported it wholeheartedly. Once our proposals are in operation and seen to work, the BMA and the rest of the medical profession will support them.

I lament the fact that the Opposition have not proposed a single new idea. I applaud the deep commitment which the Government have shown to the National Health Service by the huge increase of resources that they have committed, and continue to commit, to it. I call upon the House to reject the amendment.

6.42 pm

Rev. Martin Smyth (Belfast, South) : I followed with interest the contribution of the hon. Member for Wycombe (Mr. Whitney), particularly the valid points he made. When the Select Committee on Social Services brought out its first report on the financing of the Health Service, the Government's response was that we were plucking figures from the air. At that time we said that it would take £2 billion to bring the service into line. I welcome the fact that since then about £5 billion has been added. Therefore, we were not plucking the figures from the air, but moving in the right direction. The hon. Member for Pontypridd (Dr. Howells) talked about the problems in Wales. I realise that there is a disparity of practice throughout the country. For example, during last Thursday's lobby, I was informed that staff

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midwives were graded in an interesting way. Of those midwives, 75 per cent. were graded F in Wales, 30 per cent. in Scotland, 12 per cent. in England and 1 per cent. in Northern Ireland. There is a place for a proper balance in the National Health Service, because such grading creates discontent among people doing the same job.

Mr. Campbell-Savours : Does my hon. Friend understand that the midwives to whom he referred were graded on the basis not of skill but of the budget available for that particular discipline?

Rev. Martin Smyth : I realise that certain guidelines are given. Boards are concerned that when they carry out reviews and upgrade people to the proper grade, the Government should provide the necessary finance.

I and my colleagues in the Ulster Unionist party welcome the statement in the Queen's Speech that the Government will continue to encourage greater involvement of locally elected representatives in the affairs of Northern Ireland. If the Government are committed to that idea, perhaps they will allow local representation of political parties in Northern Ireland to have a debate about the measures proposed for the Health Service and community care, as well as social security.

Earlier this afternoon, in another context, the Secretary of State for Health said that there was no point in coming to this House. In a sense, that observation is applicable to the Members representing Northern Ireland, because the National Health Service and Community Care Bill published last week does not apply to Northern Ireland. Clause 60 provides that the Bill should be applied to Northern Ireland by order. It is appalling that such important measures as GPs' budgets, self-governing hospitals and community care--the subject of widespread public anxiety and national debate--should be applied to the Province as a postscript, or afterthought. That shows no sensitivity for the need for democratic debate on matters affecting Northern Ireland.

I know that I shall be told that there is a different legislative framework in Northern Ireland. There is a different legislative framework in Scotland, yet the Bill includes Scotland. There is no reason why Northern Ireland should not be included in the Bill. We are told that the Bill applies to Northern Ireland in relation to National Health Service trusts because people might go there for treatment. It also applies in relation to holders of offices of profit under the Crown, including health board officers and chairmen in Northern Ireland. But the real meat of the Bill will come in an Order in Council, so there will be no opportunity to probe the legislation.

I support the recommendation of the right hon. Member for Aylesbury (Mr. Raison) that a Special Standing Committee should examine the Human Fertilisation and Embryology Bill.

I call upon the Secretary of State for Northern Ireland to grant us a local forum such as a regional council or even directly elected local health and social services boards to ensure proper scrutiny and value for money of the work done in the Health Service in Northern Ireland. Before the Secretary of State dismisses such an idea, will he look into the cost of the continuing IRA campaign on Health Service resources? Genuine consultation and the proper involvement of local politicians would diminish the IRA campaign and save NHS costs.

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